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Am. J. Respir. Crit. Care Med., Volume 164, Number 11, December 2001, 2078-2084

The Association between Birthweight, Sex, and Airway Function in Infants of Nonsmoking Mothers

SOOKY LUM, AH-FONG HOO, CAROL DEZATEUX, IRIS GOETZ, ANGIE WADE, LAURA DEROOY, KATE COSTELOE, and JANET STOCKS

Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit and Center for Paediatric Epidemiology and Biostatistics, Institute of Child Health and Great Ormond Street Hospital NHS Trust; Neonatal Unit, University College Hospital, and Department of Child Health, Barts and the Royal London School of Medicine and Dentistry, Homerton Hospital, London, United Kingdom

The risk of respiratory illness and death is increased in infants of low birthweight for gestational age, but the underlying physiologic mechanisms remain unclear. We examined the hypothesis that airway function is diminished in infants of low birthweight for gestational age, independent of exposure to maternal smoking. Respiratory function was measured using partial and raised volume forced expiratory maneuvers in 103 infants (> 35 wk gestation; 56 boys) not exposed pre- or postnatally to maternal smoking who, according to birthweight, were either small (SGA; n = 38) or appropriate (AGA; n = 65) for gestational age. At testing, SGA infants were of similar postnatal age (mean [SD]: SGA 6.8 [2.4] wk, AGA 5.9 [2.3] wk), but remained shorter and lighter than AGA infants. In univariate analyses, FVC, forced expired volume in 0.4 s (FEV0.4), and FEF75 were significantly diminished in SGA compared with AGA infants (mean [95% CI of difference]: FVC: 127 versus 143 ml [-29, -2]; FEV0.4: 112 versus 125 ml [-24, -2]; and FEF75: 173 versus 203 ml s-1 [-57, -3], respectively), but these differences were no longer significant after allowing for sex and body size. Furthermore, FEF75 was on average 35 ml s-1 lower in boys than girls (95% CI: -61, -8). We conclude that diminished airway function in SGA infants shortly after birth appears to be primarily mediated through impaired somatic growth.




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